British journal of anaesthesia
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Among patients undergoing emergency laparotomy, 30-day postoperative mortality is around 10-15%. The risk of death among these patients, however, varies greatly because of their clinical characteristics. We developed a risk prediction model for 30-day postoperative mortality to enable better comparison of outcomes between hospitals. ⋯ The NELA risk prediction model for emergency laparotomies discriminates well between low- and high-risk patients and is suitable for producing risk-adjusted provider mortality statistics.
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Comparative Study
Neuraxial anaesthesia techniques and postoperative outcomes among joint arthroplasty patients: is spinal anaesthesia the best option?
Neuraxial anaesthesia is frequently used for lower limb arthroplasty but it is unclear whether benefits vary among patients receiving different subtypes of neuraxial anaesthesia. We evaluated whether differences in risk for adverse postoperative outcomes exist between patients receiving combined spinal and epidural (CSE), epidural, or spinal anaesthesia. ⋯ We identified clear differences in risk for certain postoperative events by subtype of neuraxial anaesthesia, suggesting that spinal anaesthesia is associated with the most favourable outcomes profile.
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Multicenter Study
Intraoperative ventilation settings and their associations with postoperative pulmonary complications in obese patients.
There is limited information concerning the current practice of intraoperative mechanical ventilation in obese patients, and the optimal ventilator settings for these patients are debated. We investigated intraoperative ventilation parameters and their associations with the development of postoperative pulmonary complications (PPCs) in obese patients. ⋯ NCT01601223.
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Fascial layers of the neurovascular sheath containing the brachial plexus influence distribution of local anaesthetic, hence increasing the risk of block failure when performing infraclavicular brachial plexus block (ICB). ⋯ When fascial layers are present in the neurovascular sheath, they impede the spread of injectate during infraclavicular brachial plexus block. Ultrasound detection of these fascial layers is unreliable in cadavers. These findings support the use of greater volumes of injectate or a multiple injection technique when performing this block.